In Assam, two projects named POKHILA and SPIN are together set to extensively promote mental well-being, by bringing all mental health issues to the surface and tackling them head-on through massive mobilisation of counsellors and health workers, in order to create informed awareness about the need to seek help on time. The idea is to spread the message all across the state, especially the rural sector, that one need not suffer unnoticed or in silence any more, as help is at hand.

POKHILA was developed as a state-specific initiative under the leadership of Mission Director, National Health Mission (NHM), Assam, Dr M S Lakshmi Priya, a 2014-batch IAS officer of Assam-Meghalaya cadre. The programme was rolled out with the goal of strengthening the art of counselling, to emerge as a role model for frontline health workers in reaching out to community, and to have a cadre of motivated workers with comprehensive understanding of mental and other health issues.

On World Mental Health Day, Indian Masterminds spoke to Mission Director of NHM, Assam, Dr M.S. Lakshmi Priya, IAS, to know about the two projects that aim to aggressively, but at the same time empathetically, target mental health issues in the state.

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POKHILA: THE BUTTERFLY EFFECT

The word ‘POKHILA’ is an Assamese word, which means ‘butterfly’. Just like a butterfly flies from one flower to another, carrying a message of happiness and joy in its colourful wings and sowing the beginning of new life and change, similarly, counselors and other frontline workers, engaged under different health programmes of POKHILA, will go from house to house to counsel people carrying a message of hope, to bring about behavioural changes towards positive health care.

The name POKHILA has a metaphorical significance, too. In the ‘Butterfly Effect’ cited by Meteorological Science, it is said that the flapping of a butterfly, even weeks ago and miles away, has the capacity to influence the course and intensity of a tornado. What in effect it means is, that a small change has the capacity to cause larger consequences of effects.

In the same way, in the state’s mental health context, the crucial first small steps have been taken with POKHILA with the hope that this initiative will improve health seeking behaviour and will make the existing health systems more responsiveness towards community needs.

HOW TEAM POKHILA SPREADS ITS WINGS

Explaining the initiative, Ms. Lakshmi Priya said, “The expertise of counselors and psychologists will be utilised for mobilising the resistant community by using systematic counseling approach. The programme is already rolled out as pilot project in the districts of Kamrup Rural, Dibrugarh, Barpeta, Darrang and Nagaon. Encouraging inputs have already started coming from the field, like false or distorted notions regarding health services being broken by proper counseling and the health workers showing interest in further learning. We will soon streamline the programme and roll it out all over the state.”

Guwahati-based psychiatrist Dr Prakash Barman, Consultant of National Mental Health Program and Tele Manas Cell, is leading Team POKHILA under the guidance of Mission Director, National Health Mission, Assam. The psychologists and counsellors, who have an academic background of Psychology or Social Work, form the backbone of the programme. A counsellor leads the team at the block level and is helped by a block coordinator, block community mobiliser, Asha supervisor and a multipurpose worker. They visit people in their homes and provide counselling services.

The counsellors are trained in community service, group therapy, focused psychotherapy, family counselling, and also role play and field demonstration on actual cases.

TARGET BENEFICIARIES

The team targets mental health issues, high-risk pregnant women, SAM/MAM children, teenage marriages, and school dropouts. “POKHILA members primarily focus on providing specialised counseling services to the difficult and resistant cases. POKHILA Team visits the houses of mentally ill patient who are resistant to seek treatment on their own (suicidal, schizophrenia, major depressive disorder and substance abuse) and also provide counseling to adolescents facing gender-based violence. They also use any opportunity of mass gathering or public meeting to generate awareness,” Ms. Lakshmi Priya said.

POKHILA also targets reduction of MMR (Maternal Mortality Rate) and IMR (Infant Mortality Rate) by mobilising resistant cases. The team visits the families of identified SAM/MAM (severe to moderate malnutrition) children, who are resistant to act on their own, and counsel and mobilise them for treatment. They also follow up on all high risk pregnancies and teenage pregnancy. As for out-of-school children, team members visit their homes to motivate the guardians to send them to school.

Team POKHILA is further subdivided into three groups – Supervising Team, District Field Visit Team, and the Block Team. Each Block Team consists of at least one counselor or clinical psychologist or psychiatric social worker, in addition to other heath professionals, nurses and ASHA workers. Every team member carries a POKHILA booklet, a POKHILA bag and a POKHILA badge/ID.

SPECIAL CARE FOR RESISTANT GROUP

To help the people who resist help, a list of resistant cases are compiled and, after verification, a microplan is made. On Fridays and Saturdays, the Block Team does field visits according to this microplan. After the field visit, the Team Leader or the counselor will prepare a case report of each case.

Most importantly, POKHILA team members visit the homes of the resistant group, as identified by ASHAs, and try to motivate them with empathy. If the family members are not motivated enough, the team visits them again on a subsequent date for the second time. If despite continuous persuasions, the family remains unconvinced, then the team seeks support from the district administration to motivate the resistant household members through field visit.

PROJECT SPIN FOR SUICIDE PREVENTION

Another health project that is in the pipeline will specifically address mental health conditions leading to suicide. Suicide cases are going up in the state and data shows that suicide incidences are particularly high in Lower Assam. Hajo Block of Kamrup Rural district alone reported 47 suicidal deaths in 2021-2022. Hence, it was decided that a study should be taken up to reduce the incidences of suicide.

“For this, 10 districts are being taken up as Pilot Project, which will be representative of all the communities and geography of Assam. In the first phase, a descriptive and analytical study will be done to assess the risk factors leading to suicide or suicide attempts, and evaluate the reporting system for suicide. And, in the second phase, an interventional study will be done,” Ms. Lakshmi Priya said.

The project has been named ‘SPIN’ (Suicide Prevention Initiative), and it will be implemented by the state National Mental Health Program (NMHP) team in collaboration with World Health Organisation (WHO).